冠状动脉钙化对民航飞行员早期筛查冠状动脉粥样硬化性心脏病的临床价值

The clinical value of coronary artery calcification in early screening of coronary atherosclerotic heart disease in civil pilots

目的探讨胸部CT检出的冠状动脉钙化(coronary artery calcification, CAC)对民航飞行员早期筛查冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease, CAHD)的临床价值。方法回顾性分析2 899例民航飞行员的体检资料, 根据冠状动脉造影术(coronary angiography, CAG)结果分为CAHD组和对照组, 比较两组飞行员的健康资料, 并采用二元Logistic回归模型和受试者工作特征(receiver operating characteristic, ROC)曲线分析CAC在CAHD中的临床价值。结果共诊断出CAHD患者38例, 其余2 861例为对照组。CAHD组民航飞行员平均年龄大于对照组(t=12.09, P<0.001), 平均总飞行时间多于对照组(Z=-7.68, P<0.001), 吸烟、高脂血症、糖尿病、高血压、脂肪肝、肥胖、颈动脉斑块、次极量平板运动试验阳性或可疑阳性、CAC以及加做冠状动脉CT血管造影和CAG者的比例均高于对照组, 差异均有统计学意义(χ^(2)=5.42~1 430.25, P<0.01或<0.05)。Logistic回归分析结果显示, 吸烟(OR=2.800, 95%CI:1.074~7.301, P=0.035)、肥胖(OR=3.336, 95%CI:1.243~8.956, P=0.017)、次极量平板运动试验阳性或可疑阳性(OR=17.669, 95%CI:2.923~106.756, P=0.002)和CAC(OR=96.039, 95%CI:11.439~806.396, P<0.001)是诊断CAHD的独立危险因素。ROC曲线结果显示, CAC预测CAHD的敏感性、特异性分别为97.4%、93.1%, ROC曲线下面积为0.952(P<0.001)。结论胸部CT检出的CAC在民航飞行员体检中有助于早期筛查无症状或症状不典型的CAHD。

Objective To explore the clinical value of coronary artery calcification(CAC)detected by chest CT in early screening of coronary atherosclerotic heart disease(CAHD)in civil pilots.Methods The physical examination data of 2899 civil pilots were retrospectively analyzed.Pilots were divided into CAHD group and control group based on the results of coronary angiography(CAG).The health data were compared between 2 groups and the clinical value of CAC in the diagnosis of CAHD was analyzed by using binary Logistic regression model and receiver operating characteristic(ROC)curve.Results Thirty-eight CAHD cases were diagnosed,and the remaining 2861 were in the control group.Comparing to that of control group,the average age of the pilots in CAHD group was greater(t=12.09,P<0.001),and the average total flying hours were longer(Z=-7.68,P<0.001).The proportions of smoking,hyperlipidemia,diabetes,hypertension,fatty liver,obesity,carotid plaques,positive or suspiciously positive in submaximal treadmill exercise test,CAC,as well as the proportions of taking further requested coronary CT angiography and CAG were significantly higher in the CAHD group(χ^(2)=5.42-1430.25,P<0.01 or<0.05).Logistic regression model showed that smoking(OR=2.800,95%CI:1.074-7.301,P=0.035),obesity(OR=3.336,95%CI:1.243-8.956,P=0.017),positive or suspiciously positive in submaximal treadmill exercise test(OR=17.669,95%CI:2.923-106.756,P=0.002)and CAC(OR=96.039,95%CI:11.439-806.396,P<0.001)were the independent risk factors for diagnosing CAHD.The ROC curve results suggested that the sensitivity and specificity of CAC for predicting CAHD was 97.4%and 93.1%,respectively,and the area under the ROC curve was 0.952(P<0.001).Conclusions CAC detected by chest CT in physical examination is helpful for early screening of asymptomatic or atypical CAHD in civil pilots.